Using Veronikis ligature carrier to simplify transvaginal sacrospinous colpopexy

Abstract

Pelvic organ prolapse is a common problem in women and often requires surgical management. Sacrospinous colpopexy (SSC) requires significant expertise, especially in placement of the suture into sacrospinous ligament (SSL). Veronikis ligature carrier (VLC) designed for SSC was used to facilitate suture placement and retrieval under direct visualization within the confines of the pararectal space. From December 2003 through March 2004, SSC was performed in 20 patients with VLC as part of their site-specific reconstructive pelvic surgery (group A). The historic control group (group B) included 15 patients who underwent SSC with a straight needle holder between March 1999 and March 2001. There was no significant difference in age, gravity, parity, body mass index, blood loss, and hospital stay in both groups with the diagnosis of uterovaginal prolapse or posthysterectomy vaginal vault prolapse. The median operation time for group A and group B was 35 min (range 25-40 min) and 75 min (range 45-128 min), respectively (P<0.001). It took less than 5 min to introduce two sutures through the SSL by VLC in group A but 20-40 min by straight needle holder in group B. There was no injury to the bladder, rectum, pudendal nerve, or major pelvic vessels. VLC allows rapid and safe introduction of the suspending suture through the SSL and makes SSC easy to perform.